Debate to Consider If America’s Ready for OTC Birth Control

The Irvin M. Cushner Memorial Lecture will ask whether it’s time for over-the-counter (OTC) oral contraception to come to the United States.

Eve Espey, MD, MPH

Eve Espey, MD, MPH, chair of the department of obstetrics and gynecology at the University of New Mexico School of Medicine, will argue for increased access to OTC oral contraceptives, while Jennifer Ashton, MD, MS, of Hygeia Gynecology in Englewood, NJ, and chief women’s health correspondent for “ABC News” and “Good Morning America,” will argue against OTC access. “OTC Birth Control” will take place from 1:10 – 2 pm today in Hall D.

Unintended pregnancy is a major public health problem, and removing barriers to access oral contraceptives can have a positive impact on reducing unintended pregnancies, Dr. Espey said.

Many major medical organizations, including ACOG, are in favor of OTC oral contraception, and a significant majority of countries do not have a prescription requirement. According to Dr. Espey, this shows that the trend toward easing access to oral contraception is similar to what’s happened with emergency contraception.

“Emergency contraception went from being prescription-only to pharmacy-access to OTC,” she said. “The driver behind the change in status was to make a safe medication more available and remove the requirement for the expense of the visit and other barriers. For young people, confidentiality issues are a major barrier. There’s a real role for OTC access.”

Jennifer Ashton, MD, MS

Dr. Ashton said that OTC access is the right intention, but the wrong execution. While there’s a large need for providing greater access to contraceptives for women, the OTC argument confuses access and care.

“If you remove completely the patient-doctor encounter that most women and young girls have to go through in order to be put on the pill, you’re removing a major opportunity for preventative health and wellness and STD screening and a whole host of things that women aren’t getting enough of.”

There are also medical concerns that Dr. Ashton plans to highlight during the debate. While oral contraception has proven very safe, she said, low risk is quite different than no risk.

Before any OTC changes would happen, the Food and Drug Administration would need to study women’s ability to self-screen for contraindication and understand the labeling. Dr. Espey says that she’s confident that those concepts would stand up to an actual study.

Dr. Espey believes that most women would like to have an OTC option, and that the option would be empowering.
“One of the big advantages of birth control pills is that the woman decides when she starts and stops, unlike the long-acting reversible methods,” Dr. Espey said. “There is something to be said for women having more control over when they utilize a method. Women know when they need to use a contraceptive. Making it available OTC would make it better for those times when it may be difficult to see a doctor or provider.”

Dr. Ashton worries about pill management, who will talk to women about finding the right pill, and then explain and make sure they take the pill correctly. She spends up to 30 minutes counseling patients new to oral contraception.

The laws passed in California and Oregon allowing pharmacists to prescribe oral contraception are a slippery slope, she said. While pharmacists are well-versed in pharmacodynamics, can they do the counseling that she believes is an important part of the experience? And, who will offer advice if OTC oral contraception becomes available?

“It’s generally accepted knowledge that the overall health literacy of the lay population is about at the 7th-grade level, so with one-on-one counseling and me explaining how the pill works, I have some patients come back and say, ‘Well, but when I get my period on the pill…’ They don’t even understand that you don’t get a period on the pill,” Dr. Ashton said.